NICE recommend all women should be able to have a cs

[LoveBeingAWitch]

Just seen tomorrow's front page of the Sunday times saying that NICE are saying cd has become such a safe op that every woman should be able to have one if that's what they want. Im quite surprised by this.

I don't get this.

Now there are women saying "I don't want a CS so this recommendation is wrong!!!"

But this recommendation won't force women into having CS they don't want to have.

However, not having this recommendation means that women are forced into having VB that they don't want but this is seen as right???

Honestly.

"A planned CS is safer than an EMCS and if you have been through this or close to it it seems sensible that you shouldn't have to fight like a demon and cry your eyes out at every available option not to be put through that again"

I agree.

"This is all that is under discussion"

I don't understand why we need new guidelines on c/s. There are already protocols in place for women with primary or secondary tokophobia. They are not being properly adhered to because of financial and institutional pressures on maternity services.

Don't have very strong feelings either way- I've had both types of birth and didn't feel very strongly about it either way (nice babies, though ).

But it does seem to me that it would be:

a) nice if a more helpful approach could be adopted for tokophobes

b) nice if this did not adversely affect the provision of good advice and support for natural childbirth

c) nice if it did not financially impact on other services (though I'd be happy to pay a slight tax rise)

What I do find completely odd, however, is the statement "women are designed to give birth" as meaning the equivalent of "birth must be safe and non-traumatic for the individual woman".

Have these people read biology at all? Where does it say that Nature works on the principle of the survival or comfort of the Individual? Surely the whole point of evolution is that the Species survives, not this particular giraffe or this particular woman? In some species, all individuals die at egg-laying time; it doesn't mean squids and mayflies y weren't designed to reproduce. Looking at mammals generally, it is hard not to come to the conclusion that part of the natural order is that some individuals die in childbirth, but that enough survive to raise their young and perhaps reproduce again. (Giraffes, I believe, have a particularly hard time of it).

Of course, the beauty of having evolved human brains is that we can work at getting round this, either by means of technology or through so-called Natural Methods and I am all for it. But it has sod all to do with Nature.

No evidence at all regarding breastfeeding and sections.

Sorry Posie, but how can you say that? You may wish to argue that the evidence isn't compelling, but you can't pretend that there's "no evidence" whatsoever.

US study, 2006, CS babies twice as likely to have neonatal formula feeds (interferes with success rate);

CS "significant barrier to the implementation of Baby Friendly Hospital Initiative"

UK 2005 study CS a "main determinant of bottle-feeding"

Sweden 2007 women who request CS "reastfeeding to a lesser extent three months after birth"

Those are quality scholarly articles. You shouldn't pretend they don't exist; would be better to work on fixing why those things have been observed. My same point applies to some of your other sweeping statements.

i had 2 emcs and one vb ,id rather have vb anyday ,cs should only be given in emergancys as they take longer to recover

I wasn't offered any pain relief either BTW and the pain was unbearable, I was going to knock myself out against a wall but fortunately at that point (while I was thinking right when this contraction stops I will go and do that because I can't stand it) they said I was going straight through for an EMCS.

Obviously I am not very good at "discomfort". Although that is peculiar given that I have had a lot of major surgery in my life, including as a child, due to a periodically terribly painful condition that started when I was a toddler. And I've broken the odd bone. Yet none of that was anything compared to what I felt after I was induced (pessaries, didn't get as far as the drip).

Discomfort my arse.

working I agree that the use of Keillands (sp?) forceps is appalling -- I'm from the US and was shocked to hear I might be subjected to them whilst giving birth in the UK. Even worse, whilst the consultant said he would not use them on me (big baby) the junior doctors and midwives brushed me off and said they would use them if they had to.

It was a big reason why I wanted a section and given the people I know both in real life and on MN who have had traumatic experiences with them, I don't think my fear was irrational.

I know some would say this means I wanted to 'control' my childbirth but honestly I didn't -- I knew I would have very little control. I just didn't want them to use an instrument that was banned in my home country, given my individual circumstances.

I wholeheartedly agree with Working above about CS vs. VB Childbirth should not be made into a moral issue. That attitude annoys the blank out of me, too.

I also like to see that there are people on this thread who would restrict further the conditions under which CS is currently provided on the NHS - I think their views can safely be disregarded as extremist.

iirc ragged the difference was just £50 .(HB vs hospital VB without epidural) ..but the data is old as you say and hasn't been re-studied in this country of late. my link was here

"But this recommendation won't force women into having CS they don't want to have"

Indirectly it will, if no further money is forthcoming to fund an increase in the number of operative births.

An increase in planned c/s will put pressure on obstetric services which are already inadequate.

Given that current NICE guidelines state that consultant input in complicated vaginal deliveries seems to reduce the rate of emergency c/s, I believe the reduced access to first rate obstetric care for labouring women that will inevitably come with an increase in planned operative birth, will result in more women having unplanned c/s.

screaming, we should ask why some women aren't afraid of childbirth. When I was pregnant with DS I did a hell of a lot of reading into it because I knew that the experiences of a few that I knew of would not mean I'd have the same experience. Before I did my research, I didn't really know that childbirth was not like what I'd seen on tv. However once I had, which included looking at risks, I felt a lot more prepared for it. I accepted that it was likely to be difficult and hurt etc etc (although only the end hurt, rest was fine). I was not prepared to accept the consultant's opinion that "I wouldn't cope as a first timer ) and spoke to women who had been fine as well as women who had not. That also included reading Ina May (who, as a midwife who has attended hundreds of births is not someone to be taken lightly alongside consultants who see things from a different perspective).
So many people use anecdote to make a decision, which is a little naive IMO. We need more research into this, we need midwives and obstetricians working together sharing knowledge instead of standing at opposite sides of the debate.

shagmund where is your evidence that this will increase the number of cs?

If it does increase, where is your evidence that this will be more expensive? For all you know, allowing women to choose elcs will reduce the number of very expensive labouring for ages + EMCS situations.

You don't know, do you.

Btw, if anyone can show me an online article on this story, that reports that tocophobia angle and the cost analysis properly, I'll give you a massive gold star.

Best I've seen is the Daily Fail which did actually get view point of head of the birth trauma association yesterday (despite the headline: "All women get right to caesarean birth on the NHS... even if they don't need it")
www.dailymail.co.uk/health/article-2055227/NHS-women-right-caesarean-section-birth-dont-need-it.html

And then undid that by redoing the article today, with the headline: "Now all women have the right to NHS caesareans in hugely expensive move" and removing references to tocophobia. Unbelievable pandering to "too posh to push" and tabloid sensationalism in 24 hrs!
www.dailymail.co.uk/news/article-2055498/Now-women-right-NHS-caesareans-hugely-expensive-move.html

Not seen anyone else better, including broadsheets though. Is it so much to ask for a BALANCED report than actually covers the real issues and why the changes have been made?

The NICE guidelines I'm sure have been changed because the old ones didn't cover issue of tocophobia and that it was just being put under the heading of "NOT NECESSARY". Women with tocophobia were not getting access to care they need - in some cases. The important point about the new guidelines is recognising fear as an issue and a medical consideration formally which wasn't the case previously. It puts it on the map and has to be taken more seriously now.

Sadly with reporting of this nature, I think the guidelines are just going to end up getting up binned as Trusts will take full advantage of the ignorance. Very depressing to see.

Bottom line is, who are some of you to tell someone else how they are allowed to deliver their baby?

As a woman who opted for a VB and ended up having a EMCS, I feel this is a massive step in the right direction. The thought of being pushed into a VBAC in the future makes me wonder whether to give DS a sibling(s) or not. IIRC, the figures for a successful VBAC are around 70%. It is a terrifying thought to me & seems like a stupid idea if it's almost 30% likely I'll end up with another EMCS.

My recovery was dreadfully slow, I was in excrutiating pain every day for about 9 weeks. The day after my op I couldn't stand up straight, it made me cry to pick DS up & I could barely manage to get to the loo. It would seem that recovery for an EMCS vs ELCS are quite different - people on here have said they just needed paracetamol after their ELCS, I needed cocodomol for weeks & there were days when that just didn't cut it.

If I have any more DCs, I will be requesting an ELCS. There is no way I'm going for a VBAC.

threads like this make me feel a bit down - I cant believe how little support there is for supporting "choice". No-one is forcing anyone into this, just saying you have the choice - AFTER lots of discussion/counselling. How can this possibly be a bad thing?!
Stop all this "I've had 9 children by VB, and they were FINE - that's what the female body is designed to do" crap, and support that we now have more choice. I don't believe the numbers will shoot up when people are told how a C-section works etc, anyway.

I sure this has been mentioned already, but whilst VB is "natural" we are very badly "designed" physiologically to actually give birth.

Obviously we're not designed to have CSs either, but I do think it's worth bearing in mind that other mamals have a far, far easier time giving birth than we do.

cory I sort of agree with you - life is tough and involves risks (and pain, death etc). But there are plenty of ways to reduce those risks which for some means a CS, for others it means better understanding of how labour works. I've read some interesting stuff about how the cervix dilates, for example, how birth positions can avoid some complications etc but are these incorporated into how we treat pregnant and labouring women...??!

"We need more research into this, we need midwives and obstetricians working together sharing knowledge instead of standing at opposite sides of the debate."

This is the worst thing in UK Maternity services. Tribalism.

Ragged - NICE breast feeding comments. It was considered:
From the evidence reviewed for maternal request the GDG noted that CS is associated with a longer hospital stay and a higher rate of women not breastfeeding at three months. However, they weighed this against the finding that women who had a CS described a significantly better birthing experience, both immediately postnatally and three months after birth.

The group noted that the findings for breastfeeding might have been influenced by the different demographic profile of the 2 groups of women. Women in the planned CS group were significantly older than those in the planned vaginal birth group, were more likely to have come from abroad, less likely to have received parenthood education and less likely to report their perceived health as good compared with women in the planned vaginal birth group.

"I just didn't want them to use an instrument that was banned in my home country"

I find it amazing that they've banned Keillands forceps in the States, but are still inducing VBAC mothers with a drug which is almost never used for VBAC mums in the UK because of the number of deaths it's caused in the US, directly linked with scar rupture.

And also that midline episiotomies are common practice in the US despite strong evidence linking them with severe obstetric injuries to the anus.

But there you go - strange really that all medical practice isn't informed by the best available evidence. And that there's so little demand from women for their doctors to practice in way which is proven to be safest and most effective. Especially when they're paying for it themselves......

"Of course, the beauty of having evolved human brains is that we can work at getting round this, either by means of technology or through so-called Natural Methods and I am all for it."

Sadly our 'evolved human brains' haven't stopped us developing a system of maternity care where the successful medical drive to bring and end to death and severe suffering in childbirth has resulted in an avalanche of avoidable and damaging intervention in the births of the majority of women who in the past, evidence suggests, would have delivered their babies spontaneously and without harm.

When it comes to modern childbirth we really do have a case of 'throwing the baby out with the bathwater' sadly.

Sorry Jenai I don't think we are badly designed to give birth. A baby's head can in most cases fit through a pelvis. That's why we give birth earlier than most mammals as a lot of brain development happens after birth. Badly designed would mean giving birth to more independent babies.

Baby has the best chance of getting out if pregnant women didn't sit in bad positions for a huge amount of time eg at desks and in cars or on a sofa, were encouraged to move about during labour etc etc. Also if we were fitter ie stronger pelvic floors we'd have less continence problems. Instead we are getting fatter and more unhealthy - can't be good.

Badly designed would also mean the human race would have died out millennia ago.

By saying that women are badly designed, then you imply that those who had given birth with no major issues were in some way special? And those who didn't, well were just crap.

"This is the worst thing in UK Maternity services. Tribalism"

In my view what is worse than the tribalism we see here are systems of maternity care where there is only one voice: that of obstetrics, and where midwives have been relegated to the role of obstetric nurses. That's the norm for much of the rest of the world. In the UK and other countries where midwives have a voice and are not afraid to speak up, I think maternity care is safer and more humane.

our "evolved human brains" (and becoming bipedal - although I guess the two go together) are the reason why we're so crap at giving birth compared to other mammals (including primates).

So it's women's fault because modern life means they are in office jobs rather than working in fields?

If our babies were born any more developed they wouldn't be able to get out at all.

It is clear that humans have much more difficulty giving birth than other mammals - to pretend otherwise is silly.